Medical Diseases Which Cause Kidney Stones

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Symptoms and Diagnosis

Types of Stones

Dietary Prevention

Xray/ CT Scan/ Ultrasound/ IVP

Surgical Removal/ Lithotripsy

Causes of Stones

Genetic Causes

Medical Diseases

Infections

Metabolic Syndrome and Diabetes

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Most people with kidney stones will have calcium oxalate with either elevated calcium, oxalate, and/or uric acid levels and low citrate levels.  They will not have any other causes.  However, a minority of people will have non- genetic medical conditions causing stone formation (Genetic Causes of Kidney Stones is discussed elsewhere.)  The medical conditions include the following:

Hyperparathyroidism:  The parathyroid glands are located in the neck next to the thryoid gland, hence its name. Parathyroid hormone regulates blood calcium and phosphate levels.  Most cases of hyperparathyroidism are of the non-genetic form and develop in adults (Medical Causes of Kidney Stones).  Not everyone with this disorder develops kidney stones. Other complications include osteoporosis. This disorder can be suspected if blood calcium levels are elevated and phophate levels are low.  Confirmation is made by directly measuring parathyroid hormone levels in the blood.  Treatment sometimes requires surgical removal of the thyroid gland.  Unfortunately, even after removing the parathyroid gland many people can continue to form stones. 

Medullary Sponge Kidney:  The kidneys consist of an outer cortical layer and an inner medullary region.  The medulla consists of small tubules which carry urinary fluid as it is processed in the kidney.  In sponge kidney, these tubules become dilated.  The kidney takes on a spongey appearance.  Crystals form in these dilated tubules which lead to formation of kidney stones.  In some, the medulla contains millions of calcium crystals.  The reason for crystal formation may be due to stasis of urine in the tubules.  In addition, the changes in the tubules may lead to increased calcium excretion into the urine (hypercalciuria) and renal tubular acidosis.  Medullary sponge kidney can effect one kidney more than the other.  In some patients stones seem to only occur on one side.  Additionally, there may be an increased risk for kidney infections.

Sarcoidosis:  This is an autoimmune disorder which is most common in African Americans, but does occur in all ethnic groups.  People with this disorder  have abnormal growth of lymph nodes particularly in the chest around the lungs.  These lymph nodes produce vitamin D which causes increased absorption of calcium from the diet.  This is the reason vitamin D is added to milk, to increase calcium absorption.  The increased calcium absorbed from food is excreted in the urine.  This raises urine calcium levels causing calcium crystals and stones to precipitate and form.  Treatment often requires prednisone. 

Renal Tubular Acidosis (RTA):  This disorder can develop as a consequence of certain autoimmune diseases such as Sjogren's syndrome.  There are also genetic causes discussed in Genetic Causes of Kidney Stones. People with this disorder cannot pump acid which builds up in the body into the urine.  Therefore, the urine has a high pH (i.e. not acidic) causing calcium phosphate crystals to precipitate and form into calcium phosphate stones.  Calcium phosphate does not form crystals in acidic urine. Treatment includes bicarbonate or citrate therapy to reduced the body's acidity.  (NIDDK Info Sheet)

Chronic Myelogenous Leukemia (CML):  This is a chronic blood disorder with high levels of white blood cells.  It is associated with high levels of urinary uric acid which form into stones.  Treatment includes decreasing the levels of white blood cells, maximizing water/fluid consumption, and possibly allopurinol and bicarbonate/citrate therapy.

Diarrhea/Ileostomy:  Large losses of fluid from the gastrointestinal tract can lead to dehydration and loss of bicarbonate and potassium.  This leads to small urine volumes and low urinary citrate levels.  Both calcium and uric acid stones can form.  Therapy is directed to decrease gastrointestinal fluid losses, increase urine volume and oral citrate therapy. These stones are often very difficult to prevent without decreases in diarrhea/ileostomyl losses.

Crohn's Disease and Ulcerative Colitis:  Calcium oxalate stones and uric acid stones can form.  Patients with these disorders can develop decreased fat absorption in the gut and increased oxalate absorption.  Treatment includes steroids to treat the inflammatory disorder and calcium.  Calcium binds to oxalate in the gut to prevent it from being absorbed into the body.  Absorbed oxalates will eventually be excreted in the urine and lead to stones.  Oxalate are contained in food, so the calcium is taken with food.  Uric acid stones form from low urine volume and decreased urine citrate levels as described above for diarrhea.

Urinary Tract Infections:  Urinary tract infections can cause kidney stones or complicate pre-existing stones.  This is discussed in more detail in the Infections and Kidney Stones section.

Gout: Gout is associated with both uric acid and calcium stones.  Refer to Gout information page.

Medications:  Many medicaitons used to treat common conditions can lead to kidney stones.  Although acetazolamide is used in treatment of uric acid stones, it can lead to calcium phosphate stones. Topamax (topiramate) is used for seizures and migraine headaches.  It has physical characteristics in common with acetazolamide.  Topamax can lead to high urine pH and very low citrate levels.  Triamterene used in some blood pressure medication can also contribute to kidney stone formation.